Diagnostic and Therapeutic Endoscopy / 2010 / Article / Fig 1

Review Article

Technical Refinements in Single-Port Laparoscopic Surgery of Inguinal Hernia in Infants and Children

Figure 1

Intraoperative photo showing a 2-year-old boy receiving the hooked pin method. (a) Note right side inguinal hernia and the close proximity of the vas deferens (V) and testicular vessels (T) to the ring. (b) Introduction of the vascular catheter into the preperitoneal space along left side of the hernia defect. (c) The “preperitoneal hydrodissection” method. Injection of normal saline via the vascular catheter separates the vas and vessels from the peritoneum and allows the vascular catheter (arrow) to cross over. (d, e) The indwelling needle was removed, and a nonabsorbable suture was threaded through the sheath of the catheter, with the other end of the suture remaining above the skin. The sheath was then withdrawn. (f) The hook-pin device was easily made by modifying a pin used in orthopedic surgery. The device has a hook near the tip for catching hold of the suture. (g, h) Through the same stab incision, the hook-pin was introduced along the opposite side of the hernia defect into the intraabdominal space to pick up the silk, and the suture was then pulled through the abdominal wall. (i) The hernia defect was closed and the circuit suturing was tied extracorporeally.

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